Surgeons' Disrupted Sleep Not a Safety Factor

A study designed to assess the effect of disrupted sleep on surgeons finds that surgical complications did not increase when surgeons who operated on emergency cases during the midnight to 7 AM shift operated on scheduled patients later in the day.

Surgeons with disrupted sleep, who operated on patients between midnight and 7 AM., and on different patients undergoing elective gallbladder surgeries after 7AM, did not demonstrate higher rates of complications in the second set of patients.

That's the finding from a first-of-its kind study in Tuesday's JAMA that looked at outcomes from 2,078 elective laparoscopic cholecystectomies performed by 331 Canadian general surgeons. All of the surgeons had operated on different patients who needed emergency surgery between midnight and 7 AM.

The at-risk surgeries, defined as daytime procedures performed by surgeons who had operated hours earlier, were matched with four other procedures performed by the same doctors who had not been operating hours earlier.

"There was no evidence that operating the night before was associated with conversion to open cholecystectomy, the risk of iatrogenic complications, or death from elective laparoscopic surgery performed the next day," the authors wrote.

May (11/7/2013 at 4:46 PM)
For a general surgeon,performing a laparoscopic cholecystectomy is "overlearned" behavior, similar to someone who manages to drive home safely after several drinks. The impaired individual can make it home as long as nothing out of the ordinary happens. The true difficulty for the fatigued surgeon would be addressing a complication, should one arise, or doing a more technically challenging procedure. Surgeons who are fatigued do not limit themselves to performing only laparoscopic cholecystectomies. We should not use the results of this study to justify the practice of physicians caring for patients in an impaired (fatigued)state.

john (11/6/2013 at 2:55 PM)
So we should believe that by some magical power surgeons are immune to the effects of fatigue and sleep deprivation? I'll have to read the original. I'm facinated by the claim, "errors attributable to disrupted sleep occur in common and routine tasks."

Tyco Brahe (11/6/2013 at 10:29 AM)
Why do I so not believe this study?